Edith Cavell

by Diana Souhami

  The Bois de la Cambre, Brussels central park, in the 1890s

  Edith Cavell spoke French with an unremittingly English accent and there was a family tease about the time when she took the terrier, which had hurt its tail, to the vet, and did not distinguish in pronunciation between queue and coeur so that the vet thought there was something wrong with the dog’s heart.

  Refreshing though it was for her to immerse herself in a new culture and a new language, she was biding her time. “Being a governess is only temporary,” she wrote to her cousin Eddy, “but someday, somehow, I am going to do something useful. I don’t know what it will be. I only know that it will be something for people. They are, most of them, so helpless, so hurt and so unhappy.” Helping the hurt and unhappy was more her aspiration than to be quasi-mother to privileged children in a well-off bourgeois family. Her charges had no expectation of economic self-reliance or a governess’s lot. The Belgian setting was a challenge but there was an innate incongruence in teaching the François girls to be the lady she could not aspire to be because her father did not have money.

  Edith Cavell on holiday with the François children in the summer of 1894

  Sketch by Edith Cavell of the François’ summer home, the chateau de Grenosch-Elderen, 1893

  Edith Cavell’s aloneness was inevitable. She was a stranger in a foreign land. Her upbringing and family ethos was a world away from moneyed Brussels society. She worshipped at the Anglican Church of the Resurrection, had no particular friends in Brussels, little time to herself and no social calendar of her own. The smart house in the avenue Louise was her temporary residence, not her home. She was trustworthy and well liked, but at heart dispensable. On an occasion when Paul François disparaged Queen Victoria for her prim moral tone Edith Cavell left the room. This was interpreted as her having no sense of humor, but she was homesick and offended by the family’s assumption of superiority. Once when Mme. François, disinclined to meet with callers, asked her to tell them she was out, she refused, for she would not lightly dissemble.

  Sketch of roses, August 14, 1893

  Though there was scant fulfillment in her work, there was much to enjoy. Paul François had a yacht and stables and owned a summer home: a château near Tongres in Limbourg in the Forêt de Longues near the Dutch border. On holidays and outings Edith Cavell took her watercolors and sketched the racecourse at Boitsfort where all fashionable Brussels went in the racing season, the François family’s country château, the river that ran through its grounds, the village of La Plante near Namur where she went rowing on the River Meuse, the château d’Hougoumont where the Duke of Wellington’s army defeated Napoleon in June 1815.

  Every summer too she went home to Swardeston and took seaside holidays with her family and Eddy. By 1894 both her sisters, Florence and Lilian, had moved away from home. Both had avoided the governess trap and were training as nurses. Lilian was at St. Thomas’s Hospital in London. Nursing had become a possibility now that it was removed from the stigma of an occupation for women of low character. Social change was breaking through and the instinct of charity was being channeled into a more structured approach to social problems. So-called “respectable women” could, if determined, step out of a home or quasi-home environment.

  Jack Cavell had also left home. The Reverend Cavell’s ambition for his only son was for him to go into the Church. He arranged for him to work as an assistant to the Reverend Bartlett, vicar in the nearby parish of Barnham Broom. Jack, unassertive and afraid of his father, failed in his stint as a curate’s assistant. He was shy and to hide this developed an abrupt cynical manner. His friends said this was a defense and that he was a kind man. He was widely read and liked the theater, but his father told him there was no money to spend on higher education and found him a job with the Norwich Union Insurance Company in the Consequential Loss Department.

  Jack stayed with the company all his working life. He lived alone, had transient liaisons with women, smoked heavily and drank too much. He dressed as an Edwardian with a watch on a chain and a three-piece suit. He described his work as “irksome and poorly paid … free from either great troubles or real pleasures.” He progressed from being a clerk to editing and writing nihilistic editorials for the in-house magazine. Among articles about clauses in fire policies and the retirement of company personnel he included curious brooding soliloquies about the elusiveness of love and the imminence of death.

  Edith Cavell left Brussels and the François family in 1895. Marguerite, the eldest of her charges, was by then eighteen, and the youngest, Evelyn, was eight and going to school. That spring, too, the Reverend Cavell became ill. Though he seldom defaulted on any parish duty, he missed two baptisms on April 7 and 17. Edith went home to help care for him, give support to her mother and to rethink her life’s work.

  PART TWO

  8

  NO HOSPITAL TRAINING

  By 1895 Edith Cavell had come to the end of the governess cul-de-sac and marriage was not the solution to the direction of her life. Her two sisters were trained nurses. Given her altruism, her desire to help the hurt and unhappy, to do “something useful,” “something for people,” nursing seemed a profession where she might improve people’s lives.

  Nursing in England toward the end of the nineteenth century had lost much of its historic stigma as an occupation of last resort for those “too old, too weak, too drunken, too dirty, too stupid, or too bad to do anything else.” In the early part of the century most so-called nurses were no more than untrained domestic servants. Their wages were pitiful, they were sacked without notice, many were illiterate, and drink was the notorious vice of the profession, as novels like Charles Dickens’s Martin Chuzzlewit showed. The well-to-do hired nurses of their choice in their homes to look after their sick. The poor had no money to spend on any kind of medical care. Hospitals were for the down-and-out and most would not take in patients they could not cure. Many districts had no hospital of any sort. The impoverished terminally ill went to the workhouse to die a pauper’s death. Their bodies were wrapped in a strip of calico then put in makeshift coffins of unplaned wood. Edith’s father held funeral services for the destitute at the Swainsthorpe workhouse.

  Florence Nightingale raised the profile of nursing and of hospital care. She overrode her parents’ opposition to her becoming a nurse, and campaigned for standards and structured reform. Her accounts of conditions in military hospitals in the Crimean War and her appeals for proper medical facilities for wounded soldiers were given wide publicity in the newspapers. In 1859 she published her reforming manual Notes on Nursing. The following year she founded the “Nightingale Training School for Nurses” at St. Thomas’s Hospital, where Lilian Cavell trained. Such schools reformed the whole concept of nursing and hospital provision. In 1851 there were about 8000 patients in hospitals in England and Wales. Twenty years later there were 20,000.

  Florence Nightingale introduced practical apprenticeship under a good ward sister. She began a crusade for hygienic, vigilant nursing: “sanitary nursing”—fresh air, cleanliness, common sense, good management and loving care: “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed sore, it is generally the fault, not of the disease, but of the nursing.” Her nursing methods and concerns for standards of hygiene and total patient care became the benchmark of good practice.

  Her reforms elided with recognition of the need for an integrated approach to social problems. If epidemic disease taught anything it was that people interdepended. For infection to be contained, there needed to be isolation hospitals and cohesive interaction between epidemiologists, bacteriologists, water companies, plumbers, government and inspectors. No such cohesion existed and progress was piecemeal. In moves to improve the urban environment, people began to collect and interpret facts and figures about mortality and morbidity and their connection to district and trades. Questions were asked: What is it about this place or community which makes for more s
ickness, a higher death rate and recurrent epidemics? Surgeons like Lister and Pasteur applied methodology to their hunches of why infection took root.

  A surgical operation using Joseph Lister’s carbolic antiseptic spray, c. 1880

  Women in a Salvation Army shelter, 1892. Drawn from life by Paul Renouard 1845–1924. “ARE YOU READY TO DIE” is inscribed above their beds

  Women were central to the focus for change. Louisa Twining wrote her Recollections of Workhouse Visiting and campaigned for trained nurses to treat the workhouse sick; Octavia Hill worked to improve living conditions for slum dwellers; Elizabeth Garrett Anderson broke through as a practicing doctor the year Edith Cavell was born; Emily Davies campaigned for women’s suffrage and with Florence Nightingale’s first cousin—Barbara Bodichon—founded Girton College, Cambridge, for women; Elizabeth Fry pioneered for prison reform. She was a Quaker, born into the wealthy Gurney family for whom Edith Cavell had been a day governess. When she visited Newgate Prison she found neglected women and children crowded in, and sleeping on the floor without bedding. She formed a lobbying group, “The Association for the Improvement of Female Prisoners in Newgate,” and called for female matrons, employment and education for the cooped-up women and children, and their segregation from male prisoners. She also campaigned for soup kitchens for the hungry, and the reform of mental asylums.

  Edith Cavell’s application to be an Assistant Nurse Class II, December 6, 1895

  Edith Cavell had a strong sense of social justice and she wanted a career. Her years in Belgium had given her independence from her father’s repressive rule. She was thirty on December 4, 1895. Two days later she applied to the Metropolitan Asylums Board in the Strand for any vacancy they might have in a London hospital for an Assistant Nurse Class II. Four years earlier the Board had been made responsible for hospital provision for fever and infectious diseases throughout London. On her application form Edith Cavell gave her height as five foot three and a half and her weight as eight stone. She said she had been educated in Kensington. In response to Clause 7 on the form: “present engagement, length of service, annual salary and other emoluments” she wrote with self-deprecating candor, “I have had no hospital training nor any nursing engagements whatever.” She added that if appointed she could start at any time.

  9

  THE FEVER NURSE

  Six days after applying to the Metropolitan Asylums Board, Edith Cavell began work at the Fountains Fever Hospital in Tooting in south London. She was the same age as Florence Nightingale had been when she had taken up nursing. It was a stark contrast, to go from the gentility of a grand house in the Avenue Louise in Brussels to an environment where people of all ages were gravely ill and often dying.

  The Fountains, a hastily constructed makeshift place, had opened two years previously in 1893. The Metropolitan Asylums Board was hard put to provide enough hospitals for the epidemics of infectious disease that swept through London in the 1890s. Their aim was to provide one fever bed for every thousand inhabitants. But whatever the target, success was always out of reach, for in London, where four million people lived in proximity and, if poor, in squalor, contagion spread like wildfire.

  The Fountains Fever Hospital, Tooting, 1895

  “Fever” covered typhus—spread by body lice, typhoid fever spread by infected food and untreated sewage, cholera, scarlet fever, smallpox, diphtheria, whooping cough, influenza, tuberculosis and measles. In the hope of isolating sufferers, an Infectious Diseases Act, passed in 1889, made it obligatory for general practitioners to notify local medical health officers about patients suffering from eleven types of infectious disease. Such patients were legally entitled to admission to an Asylums Board hospital irrespective of ability to pay. Early treatment was all-important but the incubation time was often weeks and the diagnosis of the certifying practitioner was too often wrong.

  Medical research and its application struggled to catch up with these epidemics. There was a war between “man and the attacking microbe”: “The infectious diseases replace each other and when one is rooted out is apt to be replaced by others which ravage the human race indifferently whenever the conditions of healthy life are wanting. They have this in common with weeds and other forms of life—as one species recedes, another advances.”

  In 1883 Edwin Klebs, professor of pathology at Zurich University, observed that a bacillus with certain characteristics occurred in the throats of diphtheria patients. The German doctor Robert Koch that same year isolated the cholera bacillus from samples of drinking water, food and clothing, and the bacterium that caused tuberculosis, but there were no antibacterial drugs and only piecemeal understanding of bacteriological spread. Perhaps the biggest contribution to London’s health was made by Joseph Bazalgette, chief engineer to the Metropolitan Board of Works. He was a small man, given to attacks of depression and asthma. He had ten children. After the Big Stink of 1858 and a cholera epidemic five years earlier that killed 10,738 people, he was given government authority to devise an underground system of pumps and pipes to carry untreated sewage out to sea.

  He became known as “the sewer king.” It took 318 million bricks to build 1300 miles of sewage pipes. His sewers saved countless lives and led to a huge reduction in cases of typhoid and cholera, but then diphtheria increased, followed by measles then whooping cough, and though the principles of immunity and vaccination and the importance of hygiene were understood, and there were vaccines for smallpox and for diphtheria, availability was haphazard.

  Sir Joseph Bazalgette (1819–91) the “sewer king.” He engineered an underground system to carry London’s untreated sewage out to sea

  In 1890 William Halstead, an American surgeon, introduced the idea of wearing rubber gloves during surgery, but there was a huge gap between understanding the need for contagion-free environments and creating them. Nor was it known quite how contagion worked. There was no vaccine for typhoid fever, which felled the privileged as well as the poor. Queen Victoria’s consort, Prince Albert, had died of it in December 1861, supposedly contracted from foul air escaping from the drains at Windsor Castle. Typhoid deaths declined by the end of the nineteenth century, with cleaner water supplies and more effective sewage disposal, but standards varied between districts.

  In London in the epidemics of the 1890s care facilities for so-called fever patients were wildly inadequate. To isolate them, hospital ships were hurriedly fitted out on the Thames Estuary. The Asylums Board bought land on the outskirts of the city to build three new hospitals. Residents near the proposed building areas reacted with panic and protest. The ten-acre site at Tooting was bought for £4,395 and the Fountains, a hospital complex of a series of single-story timber-frame huts with corrugated-iron roofs, was built and fitted out in nine weeks. Hasty building was driven by an outbreak of scarlet fever. There were sixteen wards, each with twenty-four beds, a scullery, a sister’s bedroom, a linen room and a bathroom. There were separate huts for nursing accommodation, workshops and for a mortuary.

  Staff were urgently required. To be eligible Edith Cavell needed to have had some sort of education and be of satisfactory character—no more than that. On her application form she said she had been vaccinated against smallpox fourteen years previously and had had childhood measles and whooping cough. She had not had rheumatic fever and did not have rheumatism or varicose veins—any of which might have made the long hours of physical hard work and being on her feet difficult. Miss Gibson of Laurel Court and a Norfolk neighbor, Mrs. Annette Roberts of Brinton Hall, East Dereham, wrote references for her, and Miss Dickenson, the matron at the Fountains Hospital, interviewed her. On her recommendation Edith Cavell was then appointed by the management committee.

  She was issued with her terms of employment as an Assistant Nurse Class II. Rules were strict. She must obey the matron, medical superintendents and charge nurses under whom she worked. They would tell her what to do in the wards and how to care for patients. She must take a bath and change her uniform and stockings
before leaving the hospital. She would have twelve free hours weekly, one day off a month, an occasional evening pass from 8:30 to 10 p.m. and three weeks’ holiday a year. If after six months her work was satisfactory she would be issued with a testimonial that made her eligible for promotion to Assistant Nurse Class I. To qualify as a charge nurse she needed a year’s experience at Class I and a total of two years’ service in fever nursing. Her salary would be £20 a year, rising by £1 a year to a maximum of £24. Any promotion or salary increase depended on good reports from the medical superintendent and matron.

  So began Edith Cavell’s career as a nurse and her immersion into the drama of hospital life. The hazards of fever were many. There was no understanding of dehydration. Scarlet fever led to renal complications, children with measles developed bronchopneumonia. In her seven months at the Fountains she learned the features of infectious diseases and how to differentiate them. Patients arrived by horse-drawn ambulance. They came from Wandsworth, Clapham, Lambeth and Camberwell. They were brought in suffering with high temperatures, vomiting, diarrhea and aching limbs. On arrival their own clothes were disinfected, they were dressed in two bed gowns—cotton underneath, flannel on top—and put to bed for twenty-two days. Patients stayed in hospital for a minimum of eight weeks whatever their progress. When allowed up, they were given a warm bath every evening. Those with weak hearts were given port and brandy.